Told you so

Back when I worked for a mental health clinic, I saw first hand the problems of paying for health care. It’s one thing to promise care, but when the bill comes due, providers (state or private insurance) are quick to say no. The state was the worst actually, they were quick to find any excuse not to pay and were quick to bitch when we were in the right and had to make them pay.

So when conservatives talked of “death panels”, the left and the Main Stream Media[tm] called them crazy and accused them of scaring the public.

How can we learn to say no?

The federal government is now starting to build the institutions that will try to reduce the soaring growth of health care costs. There will be a group to compare the effectiveness of different treatments, a so-called Medicare innovation center and a Medicare oversight board that can set payment rates.

But all these groups will face the same basic problem. Deep down, Americans tend to believe that more care is better care. We recoil from efforts to restrict care. …

From an economic perspective, health reform will fail if we can’t sometimes push back against the try-anything instinct. The new agencies will be hounded by accusations of rationing, and Medicare’s long-term budget deficit will grow.

So figuring out how we can say no may be the single toughest and most important task facing the people who will be in charge of carrying out reform.“Being able to say no,” Dr. Alan Garber of Stanford says, “is the heart of the issue.”
— In Medicine, the Power of NoBy DAVID LEONHARDT NYT